Zeitschrift für Geburtshilfe und Perinatologie
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1. From 1976 to 1980 858 patients with late gestoses were treated at the Department of Obstetrics and Gynecology of the Wilhelm-Pieck-University of Rostock (6,9% from 12.519 deliveries). 2. The principles of therapy with appropriate dosage of drugs are discussed in comparison to other countries. 3. ⋯ This osmoonco-therapy may be applied before or simultaneously with the administration of antihypertensive drugs. But there are controversies in this mode of treatment. 7. In our clinic the maternal mortality of 79 eclampsias was 2,25% from 1959 to 1980.
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Z Geburtshilfe Perinatol · Apr 1982
[Cord clamping at birth - considerations for choosing the right time (author's transl)].
From the historical point of view, cord clamping has been performed in natural child birth some time after the fetus has been delivered and after the expulsion of the placenta. In 1877 already Hayem could show that in late cord clamping (LC) the concentration of erythrocytes in the newborn blood is elevated if compared to early clamping (EC) of the unbilical cord. It was concluded that is was a result of placental transfusion. The underlying mechanism of the placental transfusion is the hydrostatic pressure between the placenta and the fetus, supported by uterine contraction and the time of cord clamping after birth. Placental transfusion is diminished if cord clamping is performed in less than 180 sec and if the newborn baby is positioned 20 cm and more above the placental insertion. The newborn responds to placental transfusion with an increase of hemoglobin and hematocrit, an elevated blood pressure, although significant differences in cardiac output could not be established. Renal function is increased and effective renal blood flow associated with the blood volume of the newborn. In cases of caesarean section a higher incidence of respiratory distress occurs if placental transfusion does not take place. In utero placental transfusion occurs if the fetus is hypoxic obviously to increase the oxygen supply to the fetal tissue. ⋯ "In order to give the newborn the blood, that it need physiologically cord clamping should be performed not immediately after birth, but one should wait as long until the umbilical vein has been empty and is collapsed." (Bumm 1902).
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Z Geburtshilfe Perinatol · Oct 1981
[Endometrial bacteriology in puerperal infections (author's transl)].
From the third to the sixth day postpartum transcervical endometrial swabs were taken from 51 women with the clinical signs of endometritis, like fever over 38 degree C, uterine tenderness and purulent lochia using prereduced anaerobic transport-media. The specimens were cultured aerobically and anaerobically. 27 women had an endometritis following vaginal delivery, 24 following caesarian section. Following vaginal delivery aerobic bacteria were isolated in 85.2% of the cases and anaerobic bacteria in 62.9%, post caesarian section in 75.1% aerobic and in 83.3% anaerobic bacteria. ⋯ Our results suggest that anaerobic bacterial play an important role in the endometritis post partum and that frequently a polymicrobial aerobic/anaerobic infection is present. Therapeutically, anaerobes should be taken into consideration especially for the treatment of severer infections following caesarian section. In such cases the 5-Nitroimidazoles, such as Metronidazole or antibiotics effective against anaerobes as Clindamycin or Cefoxitin should be administered.
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Z Geburtshilfe Perinatol · Feb 1981
[Experiences with single-shot peridural anaesthesia in obstetrics (author's transl)].
Analysed are the epidural anaesthesias of the years 1977 and 1978, which were carried out with the single-shot-method. Frequency of instrumental vaginal delivery of primiparae and multiparae, outcome of the newborn immediately post partum by the Apgar-score and complications compared with a group without epidural anaesthesia are being examined. There is an increase of instrumental vaginal deliveries from 5,7% to 21% after using epidural anaesthesia. ⋯ The whole rate of complication is 14,4% (here of hypotension in 7,8% of the cases). Asphyxias of the newborn are not significantly more frequent in the group with epidural anaesthesia. For the time the epidural anaesthesia remains the most effective method of analgesia during the delivery, although the maternal and fetal risk should not be underestimated.
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The article describes "obstetric spoons" which are easy to apply and which can be used as well as the forceps and the vacuum extractor for vaginal-operative termination of labor. These spoons offer the following advantages: They are an effective and relatively harmless instrument which can be applied rapidly and easily even by those who are less skilled. During extraction, the spoons are only slightly pressed onto the head of the child by the operator's hands; the additional pressure required is exercised by the soft parts of the mother. ⋯ If the traction force applied is too strong, they separate and slide over the head without exercising any further pressure. This counteracts any possible overforceful extraction. The spoons can also be applied simultaneously in combination with vacuum extraction and girdle expression, which renders even complicated vaginal surgical procedures from the mid-pelvic plane relatively harmless with regard to the strain exercised on the child.